针麻开胸手术超前镇痛作用临床观察

目的：观察开胸手术切皮前针刺麻醉是否具有手术后超前镇痛作用。方法：54例ASA（美国麻醉医师学会病情分级标准）Ⅰ-Ⅱ级食管癌择期手术患者,随机分成三组,每组18例,A组选择左右下翳风和三阳络透郄门穴位,经皮进针捻转至患者感觉酸胀为止,同侧针经同组导联连接韩氏刺激仪（LH202H型）。先进行针麻诱导15－20min,采用疏密波,1／15Hz频率,刺激强度2－4mA（以病人耐受为宜）,其后静注维库溴铵0．12mg/kg、芬太尼2μg/kg、异丙酚2mg/kg,麻醉诱导气管插管,连接麻醉机行机械通气,吸入安氟醚,为了维持麻醉,间断静注芬太尼2μg/kg/hr、维库溴铵0．03mg/kg/0.5hr,术中连续使用韩氏刺激仪, 参数同诱导时。B组除术中不用电针刺余同A组。C组（对照组）仅用药物麻醉。术后观察比较三组术后0hr、4hr、8hr、12hr、20hr、24hr各时点肌注杜冷丁人数和杜冷丁人均用量。结果：三组年龄、体重、手术和麻醉时间无显著差异。术后0－4hr、4－8hr、8－12hr、12－16hr各时段A、B、C三组肌注杜冷丁分别为2：2：9,1：2：7,1：2：6和1：3：6,C组显著多于A、B两组（P＜0．01）,但16－20hr、20－24hr两个时段两组间无显著差异。术后4hr、8hr、12hr、16hr各时点杜冷丁人均用量A、B两组均显著少于C组（P＜0．01）,但16hr后差异逐渐变小,至20hr和24hr三组已无显著差异。结论：针麻可能具有超前镇痛作用。

Clinical Observation on Preemptive Analgesia of Electroacupuncture for Patients Undergoing Thoracic Operation

Objective: To observe the effect of preemptive analgesia of electroacupuncture(EA) for patients undergoing thoracic operation. Methods: 54 adult ASA (American Standards for Assessing the State of the Patient of American Anesthesia Association) grade Ⅰ and Ⅱ patients undergoing thoracic operation were randomly divided into three groups. The single blind method was used in the study. Patients in group A (n=18) were given with EA by using Han's Acupoint Nerve Stimulator(HANS) for stimulating Xiayifeng point and Sanyangluo (SJ 8) to Ximen (PC 4; 2/15Hz, 2～4 mA and 15～ 20 min) first, then given with inhalational anesthetic (enflurane) and intravenous administration of fentany 2 μg/kg/hr, vecuronium 0.12 mg/kg/0.5 hr and propofol 2 mg/kg, During operation, HANS stimulation was given continuously, and combined with vecuronium 0.12 mg/kg. In group B (n=18), acupoint surface electrical stimulation (without acupuncture) combined with anesthetics (being same to those of group A) was given. In group C (n=18), only anesthetics were used. Then, the number of patients needing intramuscular injection of dolantin and the average doses in 3 groups were observed at 0～4 hr, 4～8 hr, 8～12 hr, 12～16 hr, 16～20 hr and 20～24 hr after operation. Results: The average dose of the injected dolantin in Group C was significantly higher than those of group A and B(P<0.001). 0～4 hr, 4～8 hr, 8～12 hr, 12～16 hr and 16～20 hr after operation, the number of patients needing intramuscular injection of dolantin in group A, B and C were 2, 2 and 9; 1, 2 and 7; 1, 2 and 6; and 1, 3 and 6 respectively. It is clear that the number of patients needing dolantin of group C is evidently more than those of group A and B (P<0.05). Conclusion: Acupuncture stimulation conducted before thoracotomy has a preemptive analgesia effect.